Organization
SURFACE CREEK FAMILY PRACTICE PC
Active
Organization
SURFACE CREEK FAMILY PRACTICE PC
Active
Parent organization
SURFACE CREEK FAMILY PRACTICE
Organization subpart
Yes
Provider details
NPI number
Legal business name
SURFACE CREEK FAMILY PRACTICE
Authorized official
MR. KEVIN L PULSIPHER D.O (PRESIDENT)
(970) 856-3146
Entity
Organization
Contact information
Practice address
255 SW 8TH AVE, CEDAREDGE, CO 81413
(970) 856-3146
(970) 806-4385
Mailing address
255 SW 8TH AVE, CEDAREDGE, CO 81413
(970) 856-3146
(970) 806-4385
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
—
—
261QH0100X
Health Service Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9000145531
—
CO
Enumeration date
10/29/2020
Last updated
10/29/2020
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